COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX641 47720 
RC96  .Un37  Relation  of  physicia 

RECAP 


United  States  £en$w$  Office 


RELATION  OF  PHYSICIANS 


TO  MORTALITY  STATISTICS 


*3> 


THE  INTERNATIONAL  CLASSI- 
FICATION OF  CAUSES  OF  DEATH 
AS  ADOPTED  BY  THE  UNITED 
STATES  CENSUS  OFFICE  AND 
APPx<OVED  BY  THE  AMERICAN 
PUBLIC   HEALTH   ASSOCIATION 


(READ  CAREFULLY  AND  PRESERVE  FOR  REFERENCE) 


1KL2L 


Q&£7 


Columbia  (Bnitorarttp 

intijeCitpoOtogork 

College  of  ^fyptiizianti  ano  Hmrgeon^ 
ILibvavp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/relationofphysicOOunit 


RELATION  OF  PHYSICIANS  TO  MORTALITY  STATISTICS. 


THE  INTERNATIONAL  CLASSIFICATION  OF  CAUSES  OF  DEATH 
AS  ADOPTED  BY  THE  UNITED  STATES  CENSUS  OFFICE  AND 
APPROVED  BY  THE  AMERICAN  PUBLIC  HEALTH  ASSOCIATION. 


This  circular  is  issued  for  the  use  and  benefit  of  physicians  who 
have  to  make  out  certificates  of  death  in  compliance  with  registra- 
tion laws,  by  acquainting  them  with  the  scope  and  requirements 
of  the  International  classification,  which  has  been  adopted  by  all 
of  the  registration  states  and  by  most  of  the  principal  registration 
cities  for  the  compilation  of  their  mortality  statistics.  Such  sta- 
tistics, to  be  comparable,  must  be  uniform ;  and  to  be  valuable  for 
scientific  purposes  they  must  be  accurate.  Their  chief  value  is 
in  the  distribution  of  deaths  by  causes,  but  the  cause  of  death 
must  be  properly  stated  before  it  can  be  properly  classified.  In 
this  particular  the  entire  value  of  the  statistics  depends  solely 
upon  the  lucidity  and  certainty  with  which  the  physicians  supply 
the  information. 

In  all  statistics  of  deaths  by  causes  there  is  much  too  large  a 
proportion  of  unknown  or  indefinite  items  for  which  the  physicians 
alone  are  directly  responsible  and  which  they  alone  can  remedy. 

It  is  probable  that  the  defect  in  this  particular  is  largely  due  to 
the  fact  that  there  has  heretofore  been  no  general  and  comprehen- 
sive plan  to  direct  the  attention  of  all  physicians  to  the  use  of  their 
certificates  for  statistical  purposes,  and  to  exhibit  the  necessities 
and  requirements  in  this  respect  by  explaining  the  classification 
used  and  by  specifying  wherein  certain  returns  are  incomplete, 
indefinite,  or  unsatisfactory.  This  circular  is  designed  to  furnish 
sUjCh  information.  It  will  be  sent  to  every  physician  in  the  coun- 
try, and  it  is  confidently  expected  that  they  will  appreciate  the 
importance  of  the  matter — the  purpose  for  which  the  circular 
is  issued — and  will  manifest  their  appreciation  by  making  their 
certificates  conform  to  the  suggestions  noted,  as  far  as  possible. 

It  should  be  considered  that  the  classification,  in  itself,  is  but 
a  selection  and  arrangement  of  titles  only,  under  which  deaths 
reported  in  thousands  of  different  ways  must  be  compiled,  and 

(3) 


that  the  assignment  of  any  death  to  the  proper  title  requires  a 
definite  statement  of  the  course  of  disease  or  the  sequence  of  causes 
resulting  in  the  death. 

The  list  of  titles  is  given  below,  and,  where  necessary,  explana- 
tory notes  are  given,  which  show  the  essential  distinctions  to  be 
made.  Some  of  the  titles — indicated  by  the  asterisk  (*) — are 
themselves  indefinite,  and  it  is  very  desirable  that  causes  of  death 
be  so  stated  as  to  permit  their  classification  under  some  more 
specific  title. 

If  physicians  will  carefully  examine  the  list  of  titles  and  observe 
the  explanations  appended,  a.  vast  improvement  can  be  made  in 
the  statistics. 

Following  the  detailed  list  and  explanation  of  the  titles  is  a  list 
of  indefinite  and  unsatisfactory  terms  very  frequently  used  by 
physicians,  with  similar  explanatory  notes.  The  terms  in  this 
list  can  not  be  properly  classified  as  given,  and  should  never  be 
used  without  further  explanation. 

It  is  suggested  that  physicians  take  a  few  cases  that  occur  to 
them  and  see  whether — if  the  causes  of  death  are  stated  in  the 
terms  they  usually  employ — they  can  themselves  classify  the 
deaths  under  some  definite  and  specific  (unstarred)  title.  This 
will  give  them  a  practical  idea  of  the  difficulties  in  the  way,  and 
of  the  sufficiency  of  their  statement  of  the  cause  of  death. 


ARRANGEMENT  OF  TITLES  OF  THE  INTERNATIONAL  CLASSIFICA- 
TION AS  ADOPTED  BY  THE  CENSUS  OFFICE. 


[Titles  marked  with  the  asterisk  (*)  are  indefinite  and  unsatisfactory.] 


List  of  titles. 


Explanatory  notes. 


ALL  CAUSES. 

I.  General  Diseases. 

(.1.  Epidemic  disease*.) 
Typhoid  fever. 

Exanthematic  typhus. 


Of  special  importance  for  sanitary  purposes,  hence  only 
exact  and  definite  statements  should  be  given  for  this 
class. 

Avoid  use  of  "  typhoid  pneumonia  "  when  pneumonic  typhoid 
or  pneumonia  occurring  as  a  complication  or  form  of 
typhoid  fever  is  meant.  Typhoid  pneumonia  will  be  com- 
piled under  "  pneumonia." 

Report  cases  exactly  in  form  of  title.  Do  not  write  "typhus" 
or  "typhus  fever,"  which  are  ordinarily  understood  as 
typhoid  fever. 


Kelapsing  fever 
Malarial  fever. 


Smallpox. 
Measles. 

Scarlet  fever- 

Whooping  cough. 

Diphtheria. 
Croup. 

Influenza  (Grip). 

Miliary  fever. 
Asiatic  cholera 
Cholera  nostras. 
Dysentery. 


Not  a  relapse,  of  fever  but  the  specific  disease  of  this  name 
is  meant. 

Do  not  use  the  terms  "malaria"  and  "malarial  fever"  in- 
definitely, but  employ  them  only  when  malarial  infection 
was  actually  a  cause  of  death.  Never  use  the  term  "  typho- 
malar  ial  fever. "  In  the  rare  cases  of  mixed  infection  state 
separately,  with  evidence  of  presence  of  both  diseases. 


When  measles  caused  bronchopneumonia  or  other  complica- 
tion, first  state  measles— and  then  the  complications. 

When  accompanied  by  complications  or  sequelae,  as  acute 
nephritis,  do  not  fail  to  give  this  as  the  primary  cause. 

In  deaths  from  bronchopneumonia  following  whooping 
cough,  the  primary  cause  should  invariably  be  stated. 

! Deaths  from  membranous  croup,  or  croup  not  specified  as 
spasmodic,  are  considered  diphtheritic.  Sequelae  of  diph- 
theria, as  paralysis  of  the  throat,  should  have  their  diph- 
theritic origin  specified. 

Only  genuine  influenza  should  be  reported  as  such.  Do  not 
use  the  term  to  cover  every  affection  of  the  respiratory 
system. 


To  be  used  only  when  true  epidemic  dysentery  is  meant.    Do 
not  use  this  term  when  ordinary  diarrhea  is  intended. 


(5) 


List  of  titles. 


Explanatory  notes. 


Plague. 

Yellow  fever. 

Leprosy. 

Erysipelas. 

Otlier  epidemic  diseases. 

(JS.  Other  general  diseases.) 


*  Septicemia . 

Glanders  and  farcy. 

Malignant  pustttle  and  char- 
boii. 

Rabies. 

Actinomycosis,     trichinosis, 
etc. 

Pellagra. 

Tuberculosis  of  lungs. 

Tuberculosis  of  larynx. 

Tuberculous  meningitis. 

Abdominal  tuberculosis. 

Pott's  disease. 

*  Tnberctilons  abscess. 
"White  swelling. 
Tuberculosis  of  otiier  organs. 
General  tuberculosis. 

*  Scrofula. 

Sypbilis. 

Gonorrhea  of  tbe  adult. 

Gonorrheal  infections   of 
children. 

Cancer  of  month. 

Cancer  of  stomach  and  liver. 

Cancer     of    intestines      and 
peritoneum. 

Cancer  of  genital  organs. 

Cancer  of  breast. 

Cancer  of  skin. 

*  Cancer  of  other  or  unspeci- 
fied organs. 

*Tumor  (noncancerous). 

Acute  articular  rheumatism . 

Chronic     rheumatism      and 
gout. 

Survey. 


Give  the  cause,  as  puerperal,  traumatic,  etc.    If  traumatic 
state  the  nature  of  the  injury,  and  whether  accidental,  etc. 


If  pulmonary  tuberculosis  was  also  involved  always  state  that 
fact. 


An  objectionable  term, 
the  cause  of  death  ? 


Was  tuberculosis,  and  in  what  form. 


Do  not  fail  to  specify  the  seat  of  cancer,  if  known.  Also  state 
as  carcinoma,  sarcoma,  etc.,  if  possible,  using  the  definite 
pathological  term  descriptive  of  the  growth  instead  of 
simply  ••cancer."  Do  not  write  "malignant  disease" 
when  cancer  is  meant. 


Do  not  write  "tumor"  when  some  form  of  cancer  is  meant. 
Always  state  organ  or  part  of  body  affected. 


.Always  define  as  acute  or  chronic. 


List  of  titles. 


Explanatory  notes. 


Diabetes. 

Exophthalmic  goiter. 
Addison's  disease. 
Leukemia. 
♦Anemia,  chlorosis. 

Alcoholism. 

Lead  poisoning-. 

Other  professional  intoxica- 
tions. 

Other  chronic  poisonings. 

Other  general  diseases. 

II.  Diseases  of  the  Nervous 
System. 

♦Encephalitis. 
Meningitis. 


Locomotor  ataxia. 

Other  diseases  of  spinal  cord. 

Apoplexy. 

Softening  of  brain. 
♦Paralysis. 

General  paralysis  of  insane. 


Other  forms  of  mental   dis- 
ease. 

Other  diseases  of  brain. 

Epilepsy. 

*  Convulsions  (nonpuerperal) . 

*  Convulsions  of  children. 

Tetanus. 

Chorea. 

Other    diseases    of    nervous 
system. 


If  anemia  is  due  to  tuberculosis,  syphilis,  or  other  disease,  so 
state.    Give  the  cause  of  the  anemia  whenever  possible. 

Always  state  the  organic  disease  resulting  from  alcoholism., 
as  cirrhosis  of  liver,  etc. 


Never  use  this  term  or  its  English  equivalent,  "  brain  fever." 

Always  specify  fully  all  deaths  that  occur  from  epidemic 
cerebro-spinal  meningitis.  Never  omit  the  word  epidemic 
or  shorten  to  cerebral,  spinal,  or  unqualified  meningitis. 
When  meningitis  results  from  tuberculosis,  traumatism 
etc.,  do  not  fail  to  specify  the  cause  of  the  meningitis. 


Do  not  report  as  "  spinal  disease"  or  the  like,  but  state  the 
definite  form  of  disease  of  spinal  cord,  if  known. 

Only  deaths  from  cerebral  hemorrhage  should  be  so  reported. 
Do  not  include  all  sudden  deaths  with  undefined  causes. 
Avoid  the  use  of  the  term  "  congestion  of  brain  "  as  a 
cause  of  death. 


Give  the  cause.  If  from  cerebral  hemorrhage,  that  fact 
should  be  stated.  If  due  to  an  affection  of  the  spinal 
cord,  name  the  specific  form. 

Do  not  fail  to  include  the  full  title,  as  otherwise  the  death 
may  be  included  among  deaths  from  paralysis  of  unde- 
fined character. 


JGive  the  disease  causing  the  convulsions,  and  in  females  of 
childbearing  age  do  not  fail  to  state  whether  pregnancy 
was  the  exciting  cause.  In  infants,  pains  should  be  taken 
to  report  diarrheal  diseases,  and  in  adults  the  presence  of 
epilepsy  or  Bright's  disease. 


List  of  titles. 


Explanatory  notes. 


Diseases  of  tlie  eye  and    its 
adnexa. 

Diseases  of  tlie  ear. 


111.  Diseases  of  the  Circu- 
latory System. 

Pericarditis. 
Endocarditis. 
Heart  disease. 


In  otitis  media,  its  cause,  as  scarlet  fever,  should  be  given,  if 
known. 


The  special  form  of  heart  disease  should  be  stated  whenever 
possible.  Never  return  "'heart  failure"  when  organic  dis- 
ease of  the  heart  was  the  cause  of  death ;  in  fact,  never  use 
the  expression  "heart  failure"  on  certificates  of  death  in 
any  case. 

Angina  pectoris. 

Diseases  of  arteries. 

Embolism  and  thrombosis. 

Diseases  of  veins. 

Diseases  of  lymphatics. 

*  Hemorrhages    (except    of    Always  state  the  cause  of  the  hemorrhage.   If  after  a  surgical 
lungs) .  operation,  state  the  disease  or  injury  for  which  the  opera- 

tion was  undertaken. 

Otner  diseases  of  circulatory 
system. 

IV.  Diseases  of  the  Respir- 
atory System. 


♦Diseases  of  nasal  fossa. 

Laryngitis. 

Other  diseases  of  larynx. 

Diseases  of  the  thyroid  body. 

Acute  bronchitis. 

Chronic  bronchitis.  | 

Bronchopneumonia. 


If  diphtheritic,  do  not  fail  to  say  so. 


Pneumonia. 

Pleurisy. 
♦Congestion  of  lungs. 


Gangrene  of  lungs. 
Asthma. 

Emphysema. 


Always  specify  definitely  as  acute  or  chronic.  Do  not  report 
chronic  bronchitis  when  pulmonary  tuberculosis  was  the 
disease  causing  death. 

Report  fully  as  bronchopneumonia,  not  as  pneumonia  un- 
qualified. 

Report  definitely  as  lobar  pneumonia  or  croupous  pneu- 
monia. Avoid  use  of  term  "typhoid  pneumonia,"  as  it 
frequently  misleads. 

If  tuberculous,  do  not  fail  to  state  the  fact. 

Never  use  this  term  on  a  certificate  of  death.  If  death  is 
due  to  pneumonia,  either  catarrhal  or  lobar,  so  state.  If 
the  condition  was  passive  congestion  of  the  lungs,  pul- 
monary edema,  or  hypostatic  pneumonia,  name  the  dis- 
ease in  which  this  condition  occurred  as  the  cause  of  death. 


List  of  titles. 


Explanatory  notes. 


♦Hemorrhage  of  lungs. 

Other  diseases  of  respiratory 

system. 

V.  Diseases  of  the  Digest- 

ive System. 

Diseases  of  mouth. 

Tonsilitis. 

Diseases  of  pharynx. 

Diseases  of  esophagus. 

TTlcer  of  stomach. 

♦Gastritis. 

Other  diseases  of  stomach. 

♦Dentition. 

Diarrhea  and   enteritis  (un- 
der 2  years). 

Diarrhea     and     enteritis    (3 
years  and  over). 

Intestinal  parasites. 

Hernia. 

Obstruction  of  intestines. 

Other  diseases  of  intestines. 

Acute     yellow     atrophy     of 
liver. 

Hydatid  tumors  of  liver. 

Cirrhosis  of  liver. 

Biliary  calculi. 

Other  diseases  of  liver. 

Diseases  of  spleen. 
Peritonitis  (nonpuerperal). 

Appendicitis. 

Other  diseases  of    digestive 
system. 

VI.  Diseases  of  the  Genito- 

urinary System. 

Acute  nephritis. 

Bright's  disease. 

Other  diseases  of  kidneys. 
Calculi  of  urinary  tract. 


Nearly  always  pulmonary  tuberculosis  should  be  stated  as 
the  cause  of  the  pulmonary  hemorrhage. 


If  diphtheritic,  say  so. 

Often  used  very  indefinitely.    Stale  cause,  if  known. 
Not  a  proper  cause  of  death.    State  disease. 


Avoid  use  of  indefinite  terms,  "  disease  of  liver,"  "  liver  com- 
plaint," and  the  like,  which  are  very  uncertain  evidence 
of  actual  disease  of  the  liver. 

Do  not  fail  to  specify  cause  of  peritonitis,  if  known,  and  in 
females  of  childhearing  age  always  state  definitely 
whether  puerperal  or  not. 


If  due  to  acute  infectious  disease,  as  scarlet  fever,  do  not 
fail  to  specify  origin  of  condition. 

Specify  definite  form.    Do  not  report  uremia  alone  without 
explaining  its  cause. 


10 


List  of  titles. 


Explanatory  notes. 


Diseases  of  bladder. 

Diseases  of  urethra,  urinary    If  due  to  gonorrhea,  so  state. 
abscess,  etc. 


of 


Diseases  of  prostate. 

No  n  venereal     diseases 
(male)  genital  organs. 

Metritis. 


Uterine    hemorrhage     (non- 
puerperal). 

Uterine    tumor    (noncancer- 
ous). 

Other  diseases  of  uterus. 

Ovarian  tumors. 

Diseases  of  tubes. 

Other  diseases  of  female  gen- 
ital organs. 

Nonpuerperal  diseases  of  the 
breast  (cancer  excepted). 

VII.  Childbirth. 

Accidents  of  pregnancy. 

Puerperal  hemorrhage. 

Other  accidents  of  labor. 

Puerperal  septicemia. 

Puerperal  convulsions. 

Puerperal    phlegmasia    alba 
dolens. 

Other  puerperal  accidents. 

Puerperal    diseases     of    the 
breast. 

VIII.  Diseases  of  the  Skin. 


Specify  definitely  as  puerperal  or  nonpuerperal. 


Gangrene. 
Carbuncle. 


Give  cause  and  part  affected. 


*  Abscess. 

Other  diseases  of  skin. 


Give  cause  and  part  affected.    Note  especially  tuberculous 

abscesses. 


IX.   Diseases  of  the  Loco- 
motor System. 


Diseases  of  bones. 
Diseases  of  joints. 
*  Amputation . 


Other  diseases  of  organs  of 
locomotion. 


Specify  cause,  as  tuberculosis,  etc.,  whenever  known. 

Amputation  for  what— disease  or  injury?   Specify  fully,  and 
if  from  injury,  note  the  nature  of  the  injury. 


11 


List  of  titles. 


Explanatory  notes. 


X.  Malformation. 
Hydrocephalus. 


Congenital  malformation   of 
heart,  cyanosis. 

Other  congenital  malforma- 
tions. 


Specify  as  congenital  hydrocephalus.  If  acute  hydrocephalus 
from  tuberculous  infection  is  meant,  specify  the  tubercu- 
lous character  of  the  disease  deiinitely. 

Report  as  congenital  malformation  of  heart  rather  than  as 
cyanosis,  the  latter  term  being  rather  indefinite. 


XI.  Early  Infancy. 

Premature  birth. 
•Congenital  debility. 

Other  diseases   of  early  in- 
fancy. 

Liack  of  care. 

XII.  Old  Age. 

•Old  age. 


XIII.  Violence. 


Give  cause,  if  known. 

What  disease  caused  the  debility  ?   This  return  is  little  more 
definite  than  to  say  from  unknown  cause. 


Name  the  disease  causing  death  in  the  old  person.  Tht 
statement  "old  age,"  in  the  vast  majority  of  cases,  is  simply 
equivalent  to  unknown,  and  shows  lack  of  observation  and 
precision  of  statement. 


Suicide  by  poison. 

Suicide  by  asphyxia. 

Suicide  by  hanging  or  stran- 
gulation. 

Suicide  by  drowning. 

Suicide  by  firearms. 

Suicide    by    cutting    instru- 
ments. 

Suicide     by    jumping     from 
high  places. 

Suicide  by  crushing. 

Other  suicides. 

Fractures.  i 

Dislocations.  ) 

Burns  and  scalds. 

Burning    by  corrosive    sub- 
stances. 

Heat  and  sunstroke. 


Cold  and  freezing. 


State  the  cause  of  the  fracture  or  dislocation. 


State  heat  or  sunstroke  only  when  the  direct  cause  of  death. 
Deaths  of  infants  from  cholera  infantum  or  of  elderly 
persons  from  heart  disease,  etc.,  although  accelerated  by 
warm  weather,  should  rather  be  reported  from  the  disease 
causing  death. 

Deaths  from  diseases  aggravated  by  cold  weather  should  not 
be  reported  under  this  title.  Specify  definitely  as  freezing 
whenever  this  was  the  case,  or  report  as  exposure  to  cold. 
Do  not  write  cold  without  qualification,  as  this  may  be 
mistaken  for  some  respiratory  disease. 


12 


List  of  titles. 


Explanatory  notes. 


Lightning. 
Drowning. 
Starvation,  privation,  etc. 


Inhalation     of     poisonous 
gases. 


Other  accidental  poisonings. 

Accidental  gunshot  wounds. 

Injuries  hy  machinery. 

Injuries  in  mines  and  quar- 
ries. 

Railroad  accidents  and  inju- 
ries. 

Injuries  by  horses  and  vehi- 
cles. 

Other     accidental      trauma- 
tisms. 

Suffocation. 

Injuries  at  birth. 

Other  external  violence. 

Homicide. 

XIV.  Ill-defined  Diseases. 

*  "  Dropsy." 

♦Sudden  death. 
*Heart  failure. 


♦Inanition  (over  3  months),  a 
♦Debility  (over  3  months),  a 

♦  Marasmus  (over  3  months) .  a 

*  Fever. 

Other  ill-defined  diseases. 
Unknown . 


Specify  as  accidental  or  suicidal  in  every  case. 

Do  not  include  inability  to  take  food  or  exhaustion  resulting 
from  disease  under  this  title,  but  state  the  name  of  the 
disease  causing  the  condition.  Only  deaths  from  inability 
to  procure  food  should  be  here  included. 

Specify  nature  of  gas  and  whether  accidental  or  suicidal.  If 
an  anesthetic  used  In  surgical  operation,  and  properly 
given,  state  the  disease  or  Injury  for  which  the  operation 
was  undertaken. 


Do  not  return  without  full  explanation  as  to  cause,  stating 
whether  by  gas  or  poisonous  vapor,  in  mine,  etc. 


Give  the  cause  of  the  dropsy,  thus  enabling  the  return  to  be 
removed  from  ill-defined  causes. 

Give  the  cause  of  the  sudden  death,  if  known. 

A  thoroughly  worthless  return.    Never  give  it  as  the  sola 
'  cause  of  death.    Name  the  disease  which  occasioned  the 
"heart  failure." 

What  was  the  cause  of  the  inanition? 

What  was  the  cause  of  the  debility? 

What  was  the  cause  of  the  marasmus  ?    If  due  to  tubercu- 
losis or  other  wasting  disease,  specify  definitely. 

What  fever  was  it?    If  not  a  specific  fever,  what  was  the 
disease  in  which  the  fever  occurred? 


a  Deaths  reported  from  this  cause  under  3  months  of  age  are  compiled  under  "  congenital  debility." 


LIST  OF  INDEFINITE  TERMS  FREQUENTLY  USED  BY  PHYSICIANS 
IN  STATING  CAUSES  OF  DEATH,  BUT  WHICH  SHOULD  BE 
AVOIDED. 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification.  . 


Abscess. 

Accident. 
Acute  gastritis. 
Acute  hydrocephalus. 
Advanced  age. 
Albuminuria. 

Amputation. 

Anasarca. 
Anemia. 

Anesthesia. 

Angina. 

Ascites. 
Asphyxia. 


Asthenia. 
Atrophy. 

Autoinfection. 

Bad  cold. 
Bed  sores. 

Bilious  attack. 


What  caused  the  abscess?  What  organ  or  part  of  the  body 
was  affected?  Was  it  tuberculous  or  resulttif  injury?  If 
of  lung,  was  it  not  pulmonary  phthisis  ? 

What  was  the  nature  of  the  accident? 

State  cause.    Was  it  due  to  some  irritant  poison  ? 

Was  this  due  to  tuberculous  meningitis? 

What  disease  caused  death  ?    See  "  Old  age." 

Name  the  acute  or  chronic  disease  causing  the  albuminuria. 
Was  it  due  to  scarlet  fever  or  Bright's  disease? 

What  was  the  disease  or  injury  requiring  the  amputation  to 
be  performed?  State  fully,  and  if  due  to  injury  from 
violence,  state  nature  of  the  accident. 

Name  disease  causing  anasarca.    See  "Dropsy." 

State  cause  of  the  anemia,  if  known.  A  death  should  not  be 
reported  thus  when  the  cause  of  the  anemia  was  pulmo- 
nary tuberculosis  or  other  wasting  disease. 

Name  the  anesthetic  and  state  whether  it  was  administered 
for  a  surgical  operation,  in  which  case  give  the  disease  or 
injury  for  which  the  operation  was  undertaken. 

Was  it  due  to  scarlet  fever  or  diphtheria?  This  is  a  sus- 
picious return  and  one  to  be  carefully  scrutinized  by 
registrars. 

Name  disease  causing  ascites.    See  "  Dropsy." 

How?  Was  it  accidental?  If  so,  state  fully  the  nature  of 
the  accident.  If  by  gases  or  poisonous  vapors,  give  par- 
ticulars. Was  it  a  case  of  "overlying"  (child)?  If  in  a 
mine,  it  should  be  so  stated.  Physiologic  asphyxiation 
(mode  of  death)  by  failure  to  eliminate  C02  should  not  be 
given  as  a  cause  alone.  What  disease  caused  this  con- 
dition ? 

A  practically  worthless  statement.  See  "  Debility. "  What 
was  the  cause? 

What  caused  the  atrophy?  Was  it  tuberculous  wasting 
(phthisis)?  Was  it  syphilis?  What  organ  or  part  atro- 
phied ? 

What  caused  the  autoinfection?  This  term  should  not  be 
used  when  cholera  infantum  or  other  diarrheal  disease  is 
meant. 

Was  it  bronchitis,  pneumonia,  or  pulmonary  consumption ? 

What  was  the  disease  causing  death  and  during  which  the 
patient  contracted  bed  sores?  Was  it  rheumatism,  par- 
alysis, etc.  ? 

Very  indefinite.    Name  disease  causing  death. 

(13) 


14 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Bilious  fever. 
Blood  poisoning. 

Bottle  feeding. 

Bowel  disease. 
Bowel  trouble. 

Brain  disease. 
Brain  disorder. 

Brain  fever. 
Breaking  down. 
Briglit's  disease. 

■Bronchitis. 

Cachexia. 

Cancer. 

Carbuncle. 

Carcinoma. 
Cardiac  asthma. 
Cardiac  asthenia. 
Cardiac  debility. 
Cardiac  failure. 
Cardiac  weakness. 
Caries. 
Casualty. 
Catarrh. 

Catarrh  of  bowels. 
Catarrh  of  lungs. 


Was  it  malarial,  typhoid,  or  other  form  of  fever?  State 
definitely. 

Do  you  mean  septicemia,  syphilis,  or  any  other  definite 
disease?  If  septicemia,  what  was  the  cause?  Was  it 
puerperal? 

This  return  is  valuable  but  only  in  connection  with  the  disease 
causing  death.  Was  the  disease  resulting  from  improper 
feeding  diarrheal  in  character? 

What  disease  of  the  bowels?  If  cholera  infantum  or  diar- 
rheal disease  of  infants,  state  definitely. 

What  was  the  "  trouble  "  ?  Name  a  definite  disease.  Was  it 
diarrhea,  dysentery,  enteritis  ?  Was  it  cancer  or  colic  or 
strangulated  hernia?  All  these  are  "troubles,"  besides 
some  others. 

Was  it  a  tumor  of  the  brain?  Was  it  meningitis?  Name 
disease  causing  death. 

What  was  the  disease  causing  death?  Was  it  paralysis, 
apoplexy,  etc.  ?  Was  it  caused  by  tuberculosis  or  syphilis  ? 
Be  definite. 

This  term  is  thoroughly  discredited.  Was  it  meningitis? 
Name  disease  causing  death. 

A  worthless  return.  What  disease  caused  the  breaking 
down  ?    See  "  Debility. " 

State  whether  acute  or  chronic.  Acute  nephritis  following 
scarlet  fever  or  other  infectious  disease  should  be  reported 
under  the  primary  cause. 

Was  it  acute  or  chronic?  If  it  extended  to  pneumonia,  the 
death  should  be  reported  from  bronchopneumonia.  See 
also  "Chronic bronchitis." 

What  disease  caused  the  cachexia?  Was  it  cancer,  syphilis, 
tuberculosis?    State  cause  definitely. 

What  organ  or  part  of  the  body  did  the  cancer  affect? 
Always  state  this. 

Was  this  anthrax  or  malignant  pustule  ?  Was  it  caused  by 
diabetes? 

What  organ  or  part  of  the  body  did  the  carcinoma  affect? 

Name  the  form  of  heart  disease  causing  death. 


These  returns  are  generally  equivalent  to  "  heart  failure,"  a 
return  which  should  never  be  made  nor  accepted.  See 
"Heart  failure." 


State  location  and  cause.    Was  it  tuberculous? 

Give  nature  of  accident. 

An  unsatisfactory  statement.    Give  location  and  preferably 
make  a  proper  statement  of  disease  causing  death. 

Was  this  diarrhea  or  enteritis  ? 

Was  this  acute  or  chronic  bronchitis,  bronchopneumonia,  or 
pulmonary  tuberculosis  ? 


15 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  lor  proper  classification. 


Catarrh  of  stomach. 
Cellulitis. 
Cerebral  coma. 

Cerebral  exhaustion. 

Childbirth. 

Choking. 

Chronic  bronchitis. 

Chronic  pneumonia. 
Chronic  senility. 
Cirrhosis. 

Cold. 

Colic. 
Collapse. 

Coma. 

Complicated  disability. 
Complications. 
Concealed  hemorrhage. 


Concussion  of  brain. 
Congenital  causes. 


Congestion. 


Congestion  of  brain. 


Very  indefinite  and  frequently  secondary  to  other  diseases 
Name  disease  causing  death. 

Give  location  and  cause.  Was  it  erysipelas?  Was  it. puer- 
peral or  traumatic? 

"Coma"  is  necessarily  cerebral  as  resulting  from  interfer- 
ence with  the  functions  of  the  brain,  but  the  cause,  of  it 
may  vary  widely.  Was  it  from  cerebral  hemorrhage, 
Bright' s  disease,  etc.?  Was  it  due  to  violence?  If  so, 
give  nature  of  accident. 

A  more  definite  statement  is  desirable  in  place  of  this  return. 
Was  it  cerebral  softening,  paretic  dementia,  etc.  ? 

Name  immediate  cause  of  death,  as  puerperal  hemorrhage, 
puerperal  convulsions,  etc. 

Give  cause.  If  in  course  of  disease,  name  the  disease  causing 
death. 

This  statement  frequently  disguises  pulmonary  tuberculosis. 
Was  the  death  caused  by  consumption? 

Was  this  not  pulmonary  tuberculosis? 

"Senility"  is  never  a  satisfactory  return.    See  "  Old  age." 

Cirrhosis  of  what  organ  ?  Of  the  brain,  spinal  cord,  liver,  or 
kidneys? 

Cold  weather  (temperature)  or  a  "cold  on  the  lungs"?  If 
freezing  is  meant,  say  so.  If  a  disease,  use  a  more  defi- 
nite term.    See  "Bad  cold." 

Name  disease  causing  colic. 

Collapse  from  what ?  Disease  or  injury?  If  from  surgical 
operation,  state  the  reason  for  the  operation.  "Collapse " 
alone  is  a  most  worthless  statement. 

What  was  the  cause  of  the  coma?  This  is  a  mere  symptom 
of  little  value  for  compilation  unless  explained.  See 
"Cerebral  coma." 

First  name  the  disease  causing  death,  and  then  the  compli- 
cations, if  desired. 

What  "complications"  of  what  primary  disease?  Name 
the  disease  causing  death. 

What  was  the  cause  of  the  concealed  hemorrhage?  Did  it 
occur  during  pregnancy  or  after  childbirth  ?  Was  it  from 
rupture  of  aneurism ?  Was  it  cerebral  hemorrhage?  If 
caused  by  violence,  what  was  the  nature  of  the  accident 
or  injury? 

What  caused  it?    State  the  nature  of  the  accident. 

What  were  the  congenital  causes  ?  Was  death  due  to  syphi- 
lis or  tuberculosis  ? 

Of  what  organ?  Did  the  congestion  amount  to  inflamma- 
tion? If  so,  it  should  be  definitely  stated.  Was  it  pas- 
sive or  hypostatic  congestion?  If  so,  name  the  disease 
from  which  it  resulted. 

Was  this  due  to  hemorrhage  (apoplexy)  ?  Was  it  some  form 
of  meningitis?    State  definitely. 


16 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Congestion  of  lungs. 


Congestive  cliill. 

Congestive  fever. 
Continued  fever. 
Convulsions. 


Cramps. 

Crusbed. 

Cyanosis. 

Debilitated. 

Debilitation  of  beart. 

Debility. 

Decrepitude. 
Defective  circulation. 


Defective  vitality. 

Delirium. 

Dementia. 

Dentition. 


Deranged  nerves. 

Despondency. 

Diarrbea. 

Diatbesis. 


Was  it  acute  bronchitis,  bronchopneumonia,  or  lobar  pneu 
monia?  If  so,  state  definitely.  "Was  it  passive  or  hypo- 
static congestion?  If  so,  name  disease  causing  the  con- 
dition. 

Was  this  a  symptom  of  malarial  fever,  pneumonia,  or  other 
acute  disease  ?  State  definitely  the  disease  causing  death. 

Was  it  malarial  or  other  fever  ?    Give  name. 

Was  it  typhoid  fever  ?    State  definitely. 

What  caused  the  convulsions  ?  Were  they  epileptic,  puer- 
peral, or  caused  by  diarrhea  or  enteritis  (infants)  ? 
Name  the  disease  in  which  the  convulsions  occurred. 
"Convulsions"  are  mere  symptoms  and  should  not  be 
given  as  equivalent  to  a  proper  statement  of  cause  of 
death. 

See  "  Convulsions  "  above.  Inquire  especially  whether  due 
to  diarrheal  disease  (infants). 

What  was  the  nature  of  the  accident?  Was  it  in  a  mine,  by 
falling  earth  in  excavation,  by  railroad  accident,  etc.  ? 

If  due  to  malformation  of  heart  in  infants,  so  state  it.  If 
due  to  organic  disease,  state  definitely. 

Name  the  disease  or  other  cause  of  the  debilitated  condition. 
See  "Debility." 

See  "Heart  failure."  This  is  a  worthless  synonym  for  an 
indefinite  return  that  should  never  be  accepted. 

What  caused  the  debility?  Name  the  acute  or  chronic  dis- 
ease. Debility  might  follow  typhoid  fever,  diphtheria, 
tubercidosis,  Bright's  disease,  and  a  host  of  other  causes. 
The  return  is  worthless  and  should  never  be  made. 


Entirely  indefinite. 
See  "Debility." 


What  was  the  cause  of  the  condition  ? 


In  infants  inquire  whether  this  was  due  to  malformation  of 
heart  (cyanosis) .  What  caused  the  defective  circulation  ? 
Was  it  due  to  organic  heart  disease  ?  This  return  may  be 
equivalent  to  the  worthless  "heart  failure." 

Indefinite.    See  "  Debility." 

Give  cause  of  delirium. 

If  any  acute  disease  caused  death  it  should  be  named,  as 
also  the  cause  of  the  dementia,  if  known. 

What  was  the  disease  causing  death  of  the  teething  child? 
"Dentition"  is  not  a  proper  cause  of  death,  and,  like 
"infantile"  and  "old  age,"  does  little  except  to  mark 
the  approximate  age  of  decedents. 

Worthless.    Name  the  disease  causing  death. 

Was  this  a  death  from  suicide  ?    If  so,  state  means  employed. 

Diarrhea  occurring  as  a  mere  symptom  of  other  diseases,  as 
tuberculosis,  cancer,  etc.,  should  not  be  reported  as  the 
cause  of  death. 

Name  actual  disease  causing  death. 


17 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Died  suddenly. 


Disease  of  brain,  bowels, 
beart,  liver,  lungs,  stom- 
ach, uterus,  or  otber  or- 
gans or  parts  of  tbe  body. 

Dropsy. 


Drowning. 
Dyspepsia. 


Eclampsia. 
Edema  of  lungs. 
Effects  of  age. 
Electrocuted. 
Emaciation. 

Encepbalitis. 

E  ndometritis . 
Epithelioma. 
Eruption. 
Eruptive  fever. 

Exhaustion. 


Failure  of  vital  powers. 

Feebleness. 
Female  trouble. 


Fever, 


Fillins  up  of  lungs. 


What  caused  the  death?  If  no  cause  can  he  ascertained, 
this  return  is  preferable  to  a  mere  guess.  Did  the  death 
occur  during  an  acute  disease  ?  Was  it  apoplexy  or  organic 
heart  disease  ?  Such  cases  may  require  investigation  by 
the  health  officer  or  coroner. 

Name  the  disease  causing  death.  Never  make  a  return  of 
the  mere  location  of  the  disease  without  specifying  its 
nature. 

Name  the  disease  in  which  the  "  dropsy"  occurred.  This  is 
a  mere  symptom  and  should  never  be  accepted  when  pos- 
sible to  secure  a  definite  statement  of  cause.  In  children 
inquire  whether  scarlet  fever  preceded.  Was  it  due  to 
organic  heart,  liver,  or  kidney  disease? 

Always  state  whether  accidental  or  suicidal,  if  known. 

Not  to  be  accepted  as  a  proper  statement  of  cause  of  death 
when  more  definite  information  can  be  obtained.  Was 
there  organic  disease  of  the  stomach  or  other  organs? 
If  so,  name  the  disease  causing  death. 

Give  cause  of  convulsions.    Were  they  puerperal? 

Give  cause.    See  "Congestion  of  lungs." 

Name  the  disease  causing  death.    See  "  Old  age." 

Was  this  legal  execution  or  accidental  death  by  electricity? 

What  caused  the  emaciation?  Was  it  pulmonary  phthisis? 
Was  it  after  some  acute  disease,  as  typhoid  fever  ?  Name 
the  disease  causing  death. 

This  term  is  deservedly  passing  out  of  use.  Name  definite 
disease.    See  "Brain  fever." 

Give  cause.    Was  it  puerperal? 

What  part  of  the  body  was  affected? 

Name  disease  causing  eruption. 

Name  the  fever  precisely.  Health  officers  should  investigate 
such  a  return  in  order  to  discover  presence  of  some  com- 
municable disease. 

What  caused  the  "exhaustion"?  This  is  a  most  worthless 
term,  but  one  frequently  returned  from  public  Institutions. 
If  after  a  surgical  operation,  name  the  disease  or  injury 
for  which  the  operation  was  undertaken. 

A  worthless  statement,  not  better  than  "debility,"  which 
see.    What  disease  caused  the  failure  of  vital  powers? 

What  disease  caused  death?    See  "Debility." 

What  was  the  disease  causing  death?  Was  it  a  uterine  or 
ovarian  tumor  or  cancer?  Was  it  a  result  of  childbirth? 
Such  an  indefinite  and  worthless  statement  as  this  should 
never  be  accepted  without  question. 

What  was  the  fever?  Was  it  enteric  (typhoid)  lever?  Was 
it  scarlet  fever  ?  Was  the  fever  merely  symptomatic  of 
some  acute  disease,  as  tuberculosis,  pneumonia  ?  Was  it 
puerperal  fever  ?  It  is  very  important  that  full  informa- 
tion be  given  in  such  a  case. 

Was  this  due  to  bronchitis?  Pneumonia?  Pulmonary  con- 
sumption ?    Name  the  disease  causing  death. 


18 


Indefinite  terras  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Fits. 

Fracture. 

Gangrene. 

Gastric  catarrh. 
Gastric  fever. 

*  General  anasarca,  a 

*  General  asthenia,  a 

*  General  breaking  down,  a 

*  General  debility,  a 

*  General  decline,  a 

*  General  dropsy,  a 

*  General  failure,  a 

*  General  inertia,  a 
General  paralysis. 


*  General  prostration,  a 

*  General  weakness,  a 
Gradual  decay. 

Gunshot  wound. 

Hanging. 

Headache. 

Head  trouble. 
Heart  clot. 

Heart  disease. 
Heart  failure. 


Were  these  epileptic  "fits "  ?    See  "Convulsions." 

What  was  the  nature  of  the  accident  causing  the  fracture? 

Did  this  follow  an  injury?  If  so,  state  nature  of  accident 
that  caused  it.    Give  cause  for  condition,  if  known. 

See  "  Catarrh  of  stomach." 

A  worthless  return.  Was  it  acute  gastritis  (q.  v.)  or  some 
definite  form  of  fever,  as  typhoid,  malarial,  etc.  ? 

See  "Dropsy." 

See  "  Asthenia." 

See  "  Breaking  down." 

See  "Debility." 

What  caused  the  decline?  Was  it  pulmonary  phthisis? 
State  disease. 

See  "  Dropsy." 

Name  the  disease  that  caused  death.  What  organ  failed  es- 
pecially?  If  heart,  see  "  Heart  failure." 

See  "Debility."  In  Southern  states  inquire  as  to  infection 
from  wncinaria. 

If  extended  paralysis  resulted  from  cerebral  hemorrhage, 
the  cause  should  be  given  and  the  expression  "  general 
paralysis"  should  be  avoided.  "General  paralysis" 
should  be  written  only  for  "  general  paralysis  of  the  in- 
sane," or  paretic  dementia,  and  the  statement  of  the  fact 
of  insanity  should  always  be  included. 

What  was  the  cause? 

What  disease  led  to  this  condition? 

What  disease  caused  the  gradual  decay?  Was  it  pulmonary 
tuberculosis  ? 

Accidental,  suicidal,  or  homicidal? 

Suicidal,  or  legal  execution? 

A  mere  symptom  without  definite  value  for  statistical  pur- 
poses.   What  disease  caused  death  ? 

Was  this  a  disease  of  the  brain  or  of  the  face  or  scalp? 
What  was  the  disease  causing  death  ? 

State  if  caused  by  embolism.  Did  it  occur  in  course  of  in- 
fectious disease?  Was  there  organic  disease  of  the 
heart? 

Better  stated  as  "  organic  heart  disease,"  and  the  exact  form 
of  the  disease,  with  its  origin,  if  known,  would  be  still 
more  desirable.  Do  not  report  "  heart  disease  "  in  every 
case  of  sudden  death  unless  it  actually  existed. 

This  return,  with  all  of  its  worthless  synonyms,  as  "cardiac 
asthenia,"  " cardiac  debility,"  "cardiac  paralysis,"  etc., 
should  never  be  accepted  as  the  sole  cause  of  death.  What 
disease  caused  the  "heart  failure"?  The  heart  always 
"fails"  before  death  from  any  cause.  Be  particularly 
careful  that  deaths  from  diphtheria,  tuberculosis,  etc.,  are 
not  so  rei»orted.  If  organic  heart  disease  is  meant  it 
should  be  so  stated. 


a  As  a  rule,  the  adjective  "  general  '■'  attached  to  an  indefinite  term  throws  no  additional  light  upon  the 
case.     The  accuracy  of  all  such  expressions  is  questionable. 


19 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Heart  trouble. 
Hematemesis . 

Hemoptysis. 
Hemorrhage . 


Hemorrhage  of  bowels. 

Hemorrhage  of  lungs. 

Hereditary  influence. 

Hydrocephalus. 

Hypostatic  congestion. 

Icterus. 
Imbecility. 

Imperfect  nutrition. 

Inanition. 


Indisposition. 
Inertia. 

Infancy. 

Infantile  asthenia. 

Infantile  atrophy. 
Infantile  debility. 
Infantile  marasmus, 
[nfirmity. 
[nfirmity  of  age. 
nflammation. 

jijury. 


Was  it  organic  heart  disease? 

Name  the  cause.  Was  it  ulcer  or  cancer  of  stomach  ?  Was 
the  blood  derived  from  the  lungs  and  was  it  a  case  of 
pulmonary,  phthisis  ? 

See  "  Hemorrhage  of  lungs." 

From  what  organ  or  part  of  the  body?  Was  it  puerperal,  or 
from  accident  or  injury?  If  the  latter,  state  nature  of 
injury  and  whether  accidental,  suicidal,  or  homicidal. 
If  from  lungs,  was  it  not  due  to  pulmonary  tuberculosis? 
Was  it  cerebral  or  from  rupture  of  aneurism  ? 

Did  this  occur  in  course  of  typhoid  fever  ?  Then  the  disease 
causing  the  hemorrhage  of  bowels  should  be  given  as  the 
cause  of  death. 

Was  this  not  due  to  pulmonary  tuberculosis  ?  If  so,  the  pri- 
mary cause  should  be  reported  without  fail. 

What  is  meant— tuberculosis ?  Syphilis?  ,  State  definite 
disease  causing  death. 

Was  it  congenital  hydrocephalus?  If  acute  hydrocephalus, 
state  whether  caused  by  tuberculous  meningitis. 

Name  the  disease  causing  the  passive  or  hypostatic  con- 
gestion. 

See  "Jaundice." 

Was  it  congenital,  or  after  disease  of  brain?  If  the  latter, 
state  cause  of  condition. 

State  name  of  disease  causing  imperfect  nutrition.  Did  it 
follow  some  disease?    If  so,  give  name  of  disease. 

This  is  a  particularly  pernicious  term  and  is  responsible  for  a 
multitude  of  worthless  certificates.  It  sounds  as  if  it 
meant  something  definite,  but,  in  the  majority  of  cases, 
it  does  not.  What  disease  caused  the  inanition?  Was  it 
syphilis,  tuberculosis,  cholera  infantum  ?  If  inability  to 
take  food,  state  cause. 

Worthless.    What  disease  caused  death? 

What  disease  caused  death  ?  Uterine  inertia^  Uncinariasis? 
See  "Debility." 

"Infancy"  is  not  a  disease  or  cause  of  death.  Infants  are 
peculiarly  liable  to  certain  affections,  which  should  be 
definitely  named.    What  disease  caused  death? 

See  "Asthenia"  and  "  Infancy."  The  term  "infantile"  adds 
no  precision  to  an  indefinite  statement. 

See  "Atrophy"  and  "Infancy." 

See  "Debility"  and  "Infancy." 

See  "Marasmus"  and  "Infancy." 

'  What  disease  caused  the  "  infirmity  "  ?    See  "  Old  age." 

Inflammation  of  what  organ  or  part  of  the  body?  State 
cause,  if  known. 

What  was  the  nature  of  the  injury,  and  was  it  accidental, 
suicidal,  or  homicidal? 


20 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Insanity. 

Internal  hemorrhage. 

Internal  injuries. 
Intestinal  hemorrhage. 

Intestinal  perforation. 

Inward  convulsions. 
Jaundice. 

Kidney  complaint. 

Kidney  disease. 
Kidney  trouble. 
Killed. 

Lack  of  energy. 
Lack  of  respiration. 

Lack  of  vitality. 
Laparotomy. 
Laryngitis. 
Liver  complaint. 

Liver  disease. 
Loss  of  Wood. 
Lung  disease. 

Lung  trouble. 
Malaria. 

Malassimilation. 
Malignant  disease. 

Malignant  fever. 
Malignant  sore  throat. 
Malnutrition . 


Give  form  of  insanity  and  immediate  cause  of  death.  . 

Hemorrhage  of  what  organ?  Rupture  of  aneurism  ?  Puer- 
peral hemorrhage?  If  due  to  external  violence,  state 
nature  of  accident. 

State  nature  of  accident  causing  internal  injuries. 

Did  this  follow  typhoid  fever?  If  due  to  injuries,  state  fully, 
nature  of  accident. 

Was  this  a  result  of  typhoid  fever?  Was  it  due  to  hernia 
or  other  intestinal  obstructions?  Was  it  the  result  of 
violence  ?    State  fully  the  cause  of  this  condition. 

Name  disease  causing  convulsions.    See  "Convulsions." 

When  jaundice  or  icterus  is  reported  for  decedents  over  three 
months  of  age,  name  disease  causing  this  condition. 

Name  the  form  of  kidney  disease  as  definitely  as  possible. 
"  Kidney  complaint"  is  very  indefinite. 

Name  the  disease. 

Name  the  disease. 

Accidental,  suicidal,  or  homicidal?  State  means  of  death. 
This  calls  for  investigation  by  a  coroner. 

Name  disease  causing  death. 

Name  the  disease  in  which  the  "  lack  of  respiration  "  occurred. 
Was  it  diphtheria?  Was  it  asphyxia  or  suffocation?  Was 
it  atelectasis  (infant)  ? 

What  disease  caused  death?    See  " Debility." 

What  was  the  disease  or  nature  of  injury  requiring  operation  ? 

Was  it  not  diphtheritic? 

Was  there  a  definite  disease  of  the  liver?  If  so,  state  it 
precisely. 

Name  the  disease. 

What  caused  the  "  loss  of  blood  "  ?    See  "  Hemorrhage." 

Was  it  acute  or  chronic  bronchitis,  bronchopneumonia,  lobar 
pneumonia,  or  pulmonary  tuberculosis  ?  Name  the  defi- 
nite disease  causing  death. 

What  was  the  name  of  the  disease?  Was  it  pulmonary 
tuberculosis  ?    Was  it  pneumonia? 

Was  death  caused  by  malarial  fever?  Do  not  use  the  term 
"malaria"  loosely,  but  limit  it  to  forms  of  disease  of 
definite  malarial  origin. 

What  disease  caused  the  malassimilation? 

Name  the  disease.  Was  it  scarlet  fever,  diphtheria,  cancer, 
or  other  disease  to  which  the  very  indefinite  adjective 
' '  malignant "  may  be  applied  ? 

Name  the  fever. 

Was  not  this  diphtheria? 

What  disease  caused  the  malnutrition? 


21 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Marasmus. 


Meningitis. 


Mental  debility. 

Metritis. 
Metroperitonitis. 
Milk  infection. 

Mortification. 
Narcotism. 

Natural  causes. 

Necrosis. 
Nephritis. 

Nervous  exhaustion. 
Nervous  fever. 

Nervous  fit. 
Nervous  shock. 

Newborn. 

No  vitality. 

Obstruction. 
Old  age. 


Operation. 

Overwork. 
Paralysis. 


What  disease  caused  the  "marasmus"?  Was  it  due  to 
tuberculosis,  syphilis,  or  cholera  infantum?  State  fully 
as  this  return  In  itself  is  practically  worthless  for  com- 
pilation. 

Was  it  epidemic  cerebro-spinal  meningitis?  If  so,  write 
exactly  in  this  form,  being  particular  not  to  omit»the 
word  "  epidemic."  Did  it  follow  scarlet  fever,  pneumonia, 
or  some  acute  infection?  If  so,  name  the  primary  dis- 
ease. Was  it  traumatic?  If  so,  state  the  nature  of  the 
violence  which  caused  the  meningitis.  Was  it  tuberculous 
meningitis? 


and  immediate   causa  of 


Give  cause  of  "mental  debility,1 
death. 

Give  cause.    Was  it  puerperal? 

Give  cause.    Was  it  puerperal? 

State  whether  diarrhea  or  enteritis  was  caused  by  the  milk 
infection. 

State  cause..  See  "Gangrene." 

Name  narcotic  employed,  and  whether  accidental,  suicidal, 
or  homicidal. 

Name  the  disease  causing  death.  The  statement  "natural 
causes  "  is  entirely  worthless,  although  frequently  reported 
by  coroners. 

Give  location  and  cause.    Was  it  tuberculous  ? 

Was  it  acute  or  chronic?  If  acute,  occurring  in  the  course 
of  some  disease,  name  the  disease  causing  death. 

Name  a  definite  disease  causing  death,  if  possible. 

Give  name  of  fever  attended  with  nervous  or  cerebral  symp- 
toms.   Was  it  typhoid  fever  ? 

See  "Convulsions." 

What  caused  the  nervous  shock?  Was  it  due  to  an  accident 
or  injury?  If  after  surgical  operation,  name  disease  or 
injury  requiring  operation. 

What  disease  caused  death  of  the  newborn  child?  See 
"Infancy."  > 

What  disease  caused  death?  What  caused  the  lack  of 
vitality? 

Obstruction  of  what  ?    Name  organ  affected. 

This  is  not  a  satisfactory  return.  The  influence  of  age  is 
shown  by  the  statement  of  age.  in  years,  months,  and 
days.  To  this  the  statement  of  "old  age"  as  a  cause  of 
death  adds  nothing  of  value.  Name  the  disease  to  which 
the  old  person  succumbed. 

Name  the  disease  or  injury  requiring  the  operation.  See 
"Surgical  operation." 

Name  disease  causing  death. 

Give  cause  of  paralysis,  if  known,  or  state  definite  form,  as 
paralysis  agitans,  infantile  paralysis,  etc.  Did  the  pa- 
ralysis follow  cerebral  hemorrhage?  Did  it  follow  some 
acute  disease?    Give  the  primary  cause. 


22 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Paralysis  of  heart. 

Pelvic  abscess. 
Pelvic  peritonitis. 
Perforation  of  bowels. 
Perimetritis. 
Peritonitis. 

Pernicious  anemia. 

Phlebitis. 
Pneumonia. 

Poisoning. 

Pregnancy. 

Progressive  asthenia. 
Prostration . 

Pulmonary  hemorrhage. 
Pyemia. 

Rash . 
Rheumatism. 

Rubeola. 
Riipture. 

Sarcoma. 
Scarlet  rash. 
Sclerosis. 

Scrofula. 

Senectus. 
Senile  anasarca. 

Senile  asthenia. 
Senile  atrophy. 
Senile  decay. 
Senile  decline, 


This  is  usually  a  mere  synonym  of  "Heart  failure"  and 
should  never  be  used  nor  accepted.    See  "  Heart  failure." 

What  was  the  cause?    Was  it  puerperal? 

What  was  the  cause?    Was  it  puerperal? 

See  "Intestinal  perforation." 

What  was  the  cause?    Was  it  puerperal? 

What  was  the  cause  of  the  peritonitis?  "Idiopathic  peri- 
tonitis" should  be  rarely  returned.  Was  it  puerperal  or 
traumatic?    In  the  latter  case,  state  mode  of  injury. 

If  any  definite  cause  can  be  assigned  for  the  anemia,  it  should 
be  reported.  Anemia  due  to  tuberculosis,  syphilis,  etc., 
should  be  returned  under  the  primary  disease. 

What  was  the  cause?    Was  it  puerperal? 

Specify  definitely  whether  bronchopneumonia  or  lobar  pneu- 
monia.   If  sequel  to  influenza,  state  that  fact. 

Name  poison,  and  whether  accidental,  suicidal,  or  homicidal. 
Autointoxication  should  not  be  returned  in  this  form,  but 
the  disease  causing  the  condition  should  be  named. 

State  cause  of  death  more  specifically.  Was  it  due  to  abortion 
or  miscarriage,  nephritis,  etc.  ?  •  4 

What  was  the  disease  causing  the  condition  ?  See  "Asthenia." 

What  disease  caused  the  prostration  ?    See  ' '  Debility. " 

Was  it  not  due  to  pulmonary  tuberculosis  ? 

What  caused  the  pyemia?  Was  it  puerperal  or  traumatic? 
If  traumatic,  state  nature  of  accident  causing  injury. 

What  was  the  disease  attended  by  rash  ?  This  is  a  suspicious 
return  and  may  indicate  scarlet  fever,  measles,  etc. 

Always  state  whether  acute  or  chronic.  If  chronic  rheuma- 
tism, note  any  organic  disease  of  heart  or  other  organs 
resulting  therefrom. 

Was  this  measles  or  German  measles  (rotheln)  ? 

Rupture  of  what  ?  If  hernia  is  meant,  it  would  be  better  so 
written,  as  "rupture"  alone  may  be  misinterpreted. 

Of  what  organ  or  part  of  the  body? 

Was  this  scarlet  fever? 

Sclerosis  of  what  organ  ?  If  cancer  (scirrhus)  is  meant,  state 
that  fact  definitely. 

A  term  now  fortunately  going  out  of  use.  State  definitely 
the  form  of  tuberculosis. 

See  "Old  age." 

See  "  Old  age"  and  "  Dropsy."  Neither  term  is  satisfactory. 
Give  disease  causing  death*. 

See ' '  Old  age ' '  and ' '  Asthenia. "   Give  disease  causing  death. 

See  "  Old  age  "  and  "  Atrophy."    State  disease  causing  death. 

See  "  Old  age."    State  disease  causing  death. 

See  "  Old  age."  Name  the  disease,  if  any,  that  caused  the 
decline. 


23 


Indefinite  terras  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Senile  degeneration. 

Senile  dementia. 
Senile  disease. 
Senile  exhaustion. 

Senile  marasmus. 

Senility. 
Sepsis. 
Septicemia. 
Septic  infection. 
Septic  poisoning. 
Shock. 

Shot. 

Simple  atrophy. 

Sloughing. 

Sore  throat. 

Specific  disease. 
Specific  infection. 
Spinal  trouble. 

Stillborn. 

Stomach  trouble. 

Stoppage. 
Strangulation. 

Stricture. 
Stroke. 

Stupor. 

Sudden. 

Suffocation. 


See  "Old age."  Degeneration  of  what  organ?  State  dis- 
ease causing  death. 

See  "Old  age." 

What  was  the  disease?    See  "  Old  age." 

See  "Old  age"  and  "Exhaustion."  Name  disease  causing 
death. 

See  "Old  age  "and  "Marasmus."  Name  disease  causing 
death. 

See  "  Old  age."    Name  disease  causing  death. 

What  caused  the  "septicemia"?  Was  it  puerperal,  trau- 
matic, or  did  it  occur  in  the  course  of  some  disease? 
Specify  fully. 


What  caused  the  shock?  If  from  injury,  state  nature  of 
accident.  If  from  surgical  operation,  state  disease  or 
injury  requiring  the  operation. 

How?    Accidental,  suicidal,  or  homicidal? 

See  "  Atrophy." 

Explain  fully,  stating  disease  or  injury. 

Was  it  not  diphtheria?  Such  a  return  in  a  fatal  case  is  ex- 
tremely suspicious,  and  a  definite  statement  should  be 
insisted  upon  by  registrars. 

Name  the  disease. 

Name  the  disease. 

Was  this  a  disease  of  the  spinal  cord  or  of  the  spine,  and, 
in  either  case,  what  was  the  disease?  Was  it  Pott's  dis- 
ease of  the  spine? 

Never  report  a  child  as  stillborn  unless  dead  at  birth.  If 
the  child  survived  any  time  whatever,  the  cause  of  death 
should  be  stated. 

Was  it  cancer,  round  ulcer,  or  other  definite  disease  of  the 
stomach?  State  fully  as  this,  alone,  is  very  indefinite 
and  unsatisfactory. 

Stoppage  of  what?  Explain  fully  and  name  disease  causing 
death. 

Was  this  strangulation  from  disease  (diphtheria) ,  choking,  or 
hanging?  If  from  disease,  state  fully.  If  from  hanging, 
state  whether  suicidal  or  legal  execution. 

Stricture  of  what  ?   Was  it  of  intestines,  esophagus,  urethra  ? 

Was  this  a  "stroke  of  apoplexy"  due  to  cerebral  hemor- 
rhage? 

What  was  the  cause  of  the  stupor,  disease,,  or  injury?  State 
fully.    See  also  "  Coma. ' ' 

What  disease  caused  the  sudden  death?  If  from  violence, 
state  means  and  whether  accidental. 

State  very  precisely  the  cause  of  the  suffocation,  as  this 
term,  returned  alone,  is  very  indefinite.    See  "  Asphyxia." 


24 


Indefinite  terms  used  in 
reporting  deaths. 


Further  information  required  for  proper  classification. 


Suicide. 

Surgical  operation. 
Surgical  shock. 

Syncope. 

Teething. 

Tonsilitis. 

Toxemia. 


Tuberculosis. 

Tumor. 

Typhoid  condition. 
Typhoid  pneumonia. 
Typho-malarial  fever. 


Typhus. 

Ulcer. 

lTremia. 

Uremic  poisoning. 

A^iolence. 

Vital  degeneration. 
"Want  of  vitality. 
Wasting. 
Weak  heart. 

Weakness. 
Wounds. 


State  means  of  death  employed. 

Always  state  the  disease  or  injury  requiring  operation.  Un- 
less the  operation  was  improper  orunskillfully  performed, 
it  should  not  be  given  as  the  primary  cause  of  death. 

What  caused  the  syncope?  Was  death  due  to  organic  heart 
disease?    Give  disease  causing  death. 

Name  the  disease  affecting  the  teething  child.  See  "  Denti- 
tion." 

Was  death  not  due  to  diphtheria?  This  is  a  suspicious 
return. 

Was  this  acute  or  chronic  poisoning  due  to  some  external 
agent  ?  If  so,  state  fully,  giving  name  of  poison,  whether 
accidental,  etc.  Was  it  autointoxication,  due  to  poisons 
generated  in  the  body  by  disease  ?  If  so,  state  the  name 
of  the  disease  causing  the  condition  which  resulted  in 
death.  Avoid  use  of  easily  misunderstood  terms  of  this 
character. 

State  organ  affected.  Do  not  fail  to  state  as  pulmonary 
tuberculosis  if  lungs  were  affected. 

Was  it  a  cancer?  Whether  a  cancer  or  tumor,  do  not  fail  to 
specify  organ  or  part  of  body  affected. 

Avoid  this  term  as  it  is  likely  to  be  mistaken  for  typhoid  fever. 

Was  the  primary  disease  typhoid  fever  or  pneumonia? 

Was  it  typhoid  fever?  Was  it  malarial  fever?  A  mixture 
of  these  diseases  rarely  occurs,  the  great  majority  of  cases 
of  so-called  "  typho-malarial  fever "  being  nothing  more 
nor  less  than  typhoid  fever. 

Was  this  not  typhoid  fever? 

State  location  and  cause. 

State  cause  of  uremia.  If  due  to  an  acute  disease,  the  latter 
should  be  named  as  the  cause  of  death.  If  in  Bright's  or 
other  organic  disease,  state  fully.    Was  it  puerperal? 

State  form  of  violence  and  whether  accidental,  suicidal,  or 
homicidal. 

Worthless.    State  disease  causing  death. 

See  "Lack  of  vitality." 

What  was  the  disease  causing  :'  wasting "  ?    See  "Atrophy." 

If  orgaric  heart  disease,  so  state  it.  Give  the  disease  caus- 
ing death.  This  return  may  be  equivalent  to  "Heart 
failure,"  which  see. 

Name  disease  causing  weakness.    See  "  Deb ility . " 

What  was  the  cause  of  the  injury,  and  was  it  accidental  or 
homicidal? 


A  copy  of  the  list  of  indefinite  returns  given  above  will  be  sent 
to  every  local  registrar  in  the  United  States  with  the  suggestion 
that  no  certificates  containing  only  these  or  similar  terms  be 
accepted,  and  no  burial  permit  be  issued,  until  the  cause  of  death 


25 

is  accurately  specified,  in  accordance  xoith  the  explanatory  notes, 
or  a  satisfactory  explanation  made. 

It  is  not  to  be  expected  that  an  entirely  definite  and  accurate 
statement  of  the  cause  of  death  can  be  made  in  every  case.  There 
will  undoubtedly  be  cases  in  which  the  exact  cause  can  not  be 
ascertained  and  others  in  which  an  accurate  diagnosis  is  impossi- 
ble, but  an  observance  of  the  suggestions  made  in  this  circular 
will  very  largely  reduce  the  number  of  deaths  that  must  neces- 
sarily be  classed  as  unknown  or  ill-defined. 


COMPLETE  RETURNS. 

THE  STANDARD  CERTIFICATE  OF  DEATH. 

"What  has  been  said  above  relates  wholly  to  the  statement  of  the 
cause  of  death,  which  is  always  furnished  by  the  physician.  But 
while  this  is  the  most  important  item,  a  complete  return  of  any 
death  requires  the  statement  of  other  personal  and  statistical  par- 
ticulars concerning  the 'death,  and  the  blank  certificate  or  return 
used  for  reporting  deaths  is  simply  a  specification,  in  convenient 
form,  of  the  legal  requirements  in  the  case,  all  of  which  are 
intended  to  be  observed. 

The  relation  to  and  influence  upon  the  mortality  from  different 
diseases,  of  age,  sex,  color,  conjugal  condition,  nativity,  parent 
nativity,  and  occupation,  are  of  the  utmost  importance,  and  the 
preparation  of  uniform  statistics  for  all  registration  states  and 
cities  requires  that  these  items,  and  others  necessary  for  record, 
shall  be  given  just  as  fully  and  as  accurately  as  the  cause  of  death. 
It  is,  therefore,  very  desirable  that  the  forms  of  certificates  used 
shall,  as  far  as  possible,  be  identical  in  substance. 

To  promote  uniformity. in  this  direction,  the  "Standard  Certifi- 
cate of  Death"  (copies  inclosed)  has  been  prepared,  in  conjunction 
with  the  Committee  on  Demography  and  Statistics  of  the  American 
Public  Health  Association,  and  has  been  approved  by  resolution 
of  the  Association.  This  form  of  certificate  has  been  adopted  by 
the  states  of  Colorado,  Illinois,  Indiana,  Michigan,  New  York,  and 
Vermont,  and  will  be  adopted  by  other  states  and  cities  as  soon' as 
the  change  can  conveniently  be  made. 

In  some  of  the  states  and  cities  the  law  requires  the  physician 
bo  supply  all  of  the  information  called  for  by  the  form  of  certificate 
used,  and  attention  is  therefore  directed  to  the  "Standard  Certifi- 
3ate"  as  indicating  the  detailed  information  generally  required. 
So  far  as  the  form  in  local  use  corresponds  to  the  Standard  Cer- 
tificate, the  facts  should  be  stated  as  called  for  in  the  latter. 


26 

Particular  attention  is  directed,  to  the  items  relating  to  conjugal 
condition,  birthplace,  birthplace  of  father  and  mother,  and  occu- 
pation, as  these  are  the  items  most  frequently  omitted  in  the 
returns.  They  all  constitute  principal  factors  in  some  of  the  statis- 
tical tables,  and  should  be  supplied  in  every  instance  if  they  can 
possibly  be  ascertained. 

Age  should  be  stated  exactly,  not  in  "round  numbers." 

Widowed  or  divorced  persons  should  not  be  reported  as  "mar- 
ried" or  "single." 

Birthplace  of.  person,  of  father,  and  of  mother  are  very  important. 

Occupation  should  always  be  reported  for  any  person  who  has 
any  remunerative  employment — women  as  well  as  men — and  in 
reporting  occupation  particular  care  should  be  taken  to  express  it  in 
such  a  way  that  it  will  not  be  confounded  with  other  occupations. 

Civil,  mechanical,  and  mining  engineers  should  be  distinguished 
from  locomotive  engineers,  and  locomotive  engineers  and  firemen 
from  those  of  stationary  engines. 

Commercial  travelers  or  salesmen  should  be  distinguished  from 
clerks  or  salesmen  in  stores. 

Miners  should  be  distinguished  as  coal,  iron,  lead,  etc. 

Mill  and  factory  operatives  should  be  distinguished  according 
to  the  product  of  the  mill,  as  woolen,  cotton,  silk,  carpet,  etc. 

Agricultural  laborers,  railroad  laborers,  and  ordinary  day  labor- 
ers should  be  distinguished  from  each  other. 

Married  women,  female  heads  of  families,  and  girls  who  are 
employed  only  in  their  own  homes  should  not  be  reported  as 
"housekeepers,"  "housewives,"  or  "housework." 

This  circular  is  one  of  a  series  designed  to  secure  uniformity  in 
the  return,  classification,  tabulation,  and  presentation  of  mortality 
statistics,  which  should  be  of  greater  importance  and  value  to 
physicians  than  to  any  other  class,  as  contributing  to  the  advance- 
ment of  medical  science;  and  the  basis  of  the  statistics  is  the 
returns  made  by  the  physicians  themselves. 

W.  A.  King, 

Chief  Statistician 
Approved  :  for  Vital  Statistics. 

Wm.  R.  Merriam, 

Director. 


& 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  rules  of  the  Library  or  by  special  arrange- 
ment with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

SfP6 

im  SB 

'•Aft  OQfo 

,OCf)   A 

dfip8     B 

95  5fp3p 

/yy$> 

<m 

f    y  ^jv^gy 

!AM  1 

3  1006 

!  s  y 

]  6  1996  FE 

_    „      JAN    I 

3  6    1996, 

n  .1*9^0 

^ 

<-'■ 

r  i-        Ifufll 

^ 

i  "  *'*& 

':      >■-* 

i 

MM     1   ft  V 

J96 

Jul  ao* 

• 

C28(ll4l)M100 

COLUMBIA  UNIVERSITY  LIBRARIES 

"6037569945 


RC96 

U.S.      Bureau  -of-  the  census. 


Un57 


